The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

WefNQ6Q8gALRJ4Aq5qcQuSPbbyZTDQzsr

LOI Applications

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Thank you for your interest in subtmitting a Letter of Intent for the UC END DISPARITIES pilot projects.

LOI Deadline is February 12, 2024 by 11:59 pm. No late LOIs will be accepted.

Please complete all listed items below.

If you have any questions, e-mail ENDDISPARITIES@mednet.ucla.edu

Applicant Name (Principal Investigator):

* must provide value

Affiliated Institution:

* must provide value

Degree(s):

* must provide value

Title at Affiliated Institution:

* must provide value

Applicant E-mail:

* must provide value

Alternative E-mail:

* must provide value

Applicant phone number:

* must provide value

Alternative phone number:

* must provide value

Proposal Title:

* must provide value

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Project Duration:

* must provide value

Amount ($) Requested Year 1:

* must provide value

Amount ($) Requested Year 2 (if applicable):

* must provide value

Name(s) of Co-Investigator(s):

* must provide value

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Name of your Primary Mentor:

* must provide value

E-mail address of your Primary Mentor:

* must provide value

Do you have a confirmed Community Partner?

* must provide value

Yes

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Community Partner(s):

* must provide value

Expand

Who do you plan to partner with?

* must provide value

Expand

Point of Contact at Community Partner(s):

* must provide value

Expand

Applicant Gender:

* must provide value

Male

Female

Nonbinary

Other

Decline to state

reset

Applicant Race (click all that apply):

* must provide value

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Applicant Ethnicity:

* must provide value

Hispanic or Latino

Not Hispanic or Latino

reset

Biosketch for All Principle Investigators and Mentors (combine into one document):

* must provide value

Upload file

Letter of Intent (LOI):

* must provide value

Upload file

Optional Files (i.e. Letters of Support, etc).

Optional File 1:

Upload file

Optional File 2:

Upload file

Optional file 3:

Upload file

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